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I have just seen a patient who has Type 2 diabetes, hypertension and hyperlipidaemia.

He had a high-pitched (? stenotic) quadphasic signal through the right posterior tibial artery alone. Dorsalis pedi and perforating peroneals were either mono or biphasic and regular.

Having not ever heard a quadphasic signal before, I wondered if it may represent some type of strange hemodynamic effect from a more proximal occlusion. Capillary fill times and cutaneous skin perfusion all appear satisfactory.

Any advice and thoughts appreciated. Obviously its not related to cardiac or abdominal aorta issues, so must be infrainguinal and probably infrapopliteal to the right side.

LL

 

LL:

A quadphasic waveform on Doppler is possible as a late diastolic wave that probably results from just the right combination of vascular wall compliance/elasticity in the arteries proximal and distal to the posterior tibial artery. This reference has a diagram of a Doppler waveform that some would call "quadphasic".

We played around with Doppler quite a lot during my first year surgical residency from 25 years ago (Kirby KA, Arkin DB, Laine W: Digital systolic pressure determination in the foot. JAPMA, 77: 340-342, 1987).